Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Clin Infect Dis. 2020 Dec 17;71(10):2637-2644. doi: 10.1093/cid/ciz1145.
Human immunodeficiency virus pre-exposure prophylaxis (PrEP) clinical guidelines recommend men who have sex with men (MSM) PrEP users be screened biannually for syphilis and gonorrhea/chlamydia at all anatomic sites. We sought to determine the proportion screened and positive by STI and anatomic site at PrEP initiation and PrEP-care visits and patient-level characteristics associated with screening among MSM PrEP users in Baltimore City, Maryland.
Medical records among MSM initiating PrEP between 30 September 2015 and 31 March 2018 were abstracted. STI screening (syphilis and gonorrhea/chlamydia at all anatomic sites) and positivity at PrEP visits ≤12 months following initiation were calculated. Poisson regression with cluster robust SEs was used to assess associations with STI screening.
Among 290 MSM initiating PrEP, 43.1% (n = 125) were screened per guidelines at PrEP initiation; 79.3% (230), 69.3% (201), 55.9% (162), and 69.3% (201) were screened for syphilis, urogenital, rectal, and oropharyngeal gonorrhea/chlamydia, respectively. Positivity among those screened was syphilis, 7.8% (n = 18/230); gonorrhea, 5.0% urogenital (10/201), 11.1% rectal (18/162), and 7.5% oropharyngeal (15/201); chlamydia, 5.0% urogenital (10/201), 11.7% rectal (19/162), and 1.5% oropharyngeal (3/201). Reported anal and oral sex (vs neither) was independently associated with STI screening (aPR, 2.11; 1.05-4.27) at PrEP initiation. At biannual PrEP-care visits, STI screening was lower and syphilis and rectal gonorrhea/chlamydia positivity was higher.
Observed STI screening levels and disease burden suggest the effectiveness of STI screening in PrEP care for STI prevention may be limited. Our results suggest providers may be offering screening based on sexual practices; clarification of STI screening guidelines for PrEP users is needed.
人类免疫缺陷病毒暴露前预防 (PrEP) 临床指南建议男男性行为者 (MSM) PrEP 用户每半年在所有解剖部位筛查梅毒和淋病/衣原体。我们旨在确定在巴尔的摩市 MSM PrEP 用户中，在开始 PrEP 和 PrEP 护理就诊时按性传播感染 (STI) 和解剖部位筛查的比例和阳性率，以及与筛查相关的患者特征。
从 2015 年 9 月 30 日至 2018 年 3 月 31 日期间开始接受 PrEP 的 MSM 中提取医疗记录。计算 PrEP 就诊时的 STI 筛查（所有解剖部位的梅毒和淋病/衣原体）和阳性率。采用带有聚类稳健标准误的泊松回归评估与 STI 筛查相关的关联。
在 290 名开始 PrEP 的 MSM 中，43.1%（n=125）按照指南在 PrEP 开始时进行了筛查；79.3%（230）、69.3%（201）、55.9%（162）和 69.3%（201）分别筛查了梅毒、泌尿生殖道、直肠和口咽淋病/衣原体。在接受筛查的人群中，梅毒的阳性率为 7.8%（n=18/230）；淋病分别为泌尿生殖道 5.0%（10/201）、直肠 11.1%（18/162）和口咽 7.5%（15/201）；衣原体分别为泌尿生殖道 5.0%（10/201）、直肠 11.7%（19/162）和口咽 1.5%（3/201）。报告的肛门和口腔性行为（而非两者都没有）与 PrEP 开始时的 STI 筛查（aPR，2.11；1.05-4.27）独立相关。在每半年的 PrEP 护理就诊时，STI 筛查的比例较低，梅毒和直肠淋病/衣原体的阳性率较高。
观察到的 STI 筛查水平和疾病负担表明，STI 筛查在 PrEP 护理中的有效性可能有限，用于 STI 预防。我们的结果表明，提供者可能根据性行为提供筛查；需要为 PrEP 用户澄清 STI 筛查指南。
